title: Relationship between quality of life and distress in infertility: a validation study of the Dutch FertiQoL.
abstract: BACKGROUND
  This study examined the relationship between emotional distress as measured by the Hospital Anxiety and Depression Scale (HADS) and the Fertility Quality of Life (FertiQoL) questionnaire.
  
  
  METHODS
  The FertiQoL and HADS were distributed to a random sample of 785 patients attending 29 Dutch clinics for medically assisted reproduction. FertiQoL was psychometrically tested for reliability. Pearson's correlations were calculated between subscales of FertiQoL and HADS. Using an independent t-test, differences between patient subgroups were computed for both instruments. The threshold for clinically meaningful depression/anxiety on the HADS subscales was used to ascertain the critical threshold for high distress on the FertiQoL scales.
  
  
  RESULTS
  FertiQoL and HADS were completed by 583 patients (response 74%). Reliability of FertiQoL scales was high (reliability coefficient between 0.72 and 0.91). Significant negative correlations were found between FertiQoL subscales and HADS scores for anxiety and depression, ranging from -0.29 to -0.71. Means on FertiQoL scales and HADS scales of couples undergoing an assisted reproductive technology (ART) treatment and a non-ART treatment did not differ significantly. Patients scoring above the HADS threshold for pathology on anxiety had an average FertiQoL score of 58.8, whereas patients exceeding the HADS depression threshold had a FertiQoL total score of 51.9 (range 0-100).
  
  
  CONCLUSIONS
  Our study confirms the expected negative relation between quality of life as measured by FertiQoL and anxiety and depression. The data support that FertiQoL reliably measures QoL in women facing infertility. FertiQoL enables clinicians to tailor care more specifically to the patient in a comprehensive way.
authors.affiliation: Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Nijmegen, The Netherlands. a.aarts@obgyn.umcn.n
authors.forename: J W M
authors.initials: JW
authors.lastname: Aarts
authors.forename: I W H
authors.initials: IW
authors.lastname: van Empel
authors.forename: J
authors.initials: J
authors.lastname: Boivin
authors.forename: W L
authors.initials: WL
authors.lastname: Nelen
authors.forename: J A M
authors.initials: JA
authors.lastname: Kremer
authors.forename: C M
authors.initials: CM
authors.lastname: Verhaak
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D007247:Infertility, Female / Q000523:psychology* / Q000628:therapy; D011594:Psychometrics; D011788:Quality of Life / Q000523:psychology*; D027724:Reproductive Techniques, Assisted / Q000523:psychology